<%@ page language="java" contentType="text/html; charset=US-ASCII" pageEncoding="US-ASCII"%>
<%@ taglib prefix="s" uri="/struts-tags"%>
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=US-ASCII">
<link rel="stylesheet" type="text/css" href="/css/mycss.css">
<link rel="stylesheet" type="text/css" href="/css/jquery.timepicker.css">
<link rel="stylesheet" type="text/css" href="/css/bootstrap-datepicker.css">
<script type="text/javascript" src="/js/jquery-1.11.0.min.js"></script>
<script type="text/javascript" src="/js/jquery.timepicker.js"></script>
<script type="text/javascript" src="/js/bootstrap-datepicker.js"></script>
<script type="text/javascript" src="/js/patientInfoUpdate.js"></script>
<title>update patient information</title>
</head>
<body>
	<div id="messageDiv" style="display: none"></div>
	<!-- 
	<s:url action="goBackToPatientHome" namespace="/patient" var="goBackToPatientHome"></s:url>
	<s:a href="%{goBackToPatientHome}">go back</s:a>
	 -->
	<br />
	<form action="javascript:updateInfo();" class="selectForm">
		<h1>update information</h1>
		<label>
        <span>First name:</span>
        <input id="firstname" type="text" name="firstname"/>
    </label>
    <label>
        <span>Last name:</span>
        <input id="lastname" type="text" name="lastname"/>
    </label>
    <label>
        <span>Date of birth:</span>
        <input id="dateOfBirth" name="date" type="text">
    </label>
     <label>
        <span>Gender:</span>
        <select name="gender">
        <option value="-1" selected="selected">Select gender</option>
        <option value="male">male</option>
        <option value="female">female</option>
        </select>
    </label>
    <label>
        <span>Home phone number:</span>
        <input id="phoneNum" type="text" name="phoneNum"/>
    </label>
    <label>
        <span>Cellphone number:</span>
        <input id="cellphone" type="text" name="cellphone"/>
    </label>
    <label>
        <span>Email:</span>
        <input id="email" type="text" name="email"/>
    </label>
    <label>
        <span>Address:</span>
        <textarea id="address" name="address" rows="3" cols="30"></textarea>
    </label> 
    <label>
        <span>Postal code:</span>
        <input id="postalCode" type="text" name="postalCode"/>
    </label>
    <label>
        <span>Current health:</span>
        <textarea id="currentHealth" name="currentHealth" rows="3" cols="30"></textarea>
    </label>
		<button id="updateInfo" type="submit" class="button">Submit</button>
	</form>
</body>
</html>